Research compares trajectories of high-need patients across nations

A new set of papers takes an in-depth look at healthcare spending, use of hospitals and rehabs, and health outcomes across 11 countries for high-need, high-cost (HNHC) patients—those who are frail and have multiple chronic conditions.

The research, published in a special issue of Health Services Research (December 2021), was led by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC), founded in 2018 by Jose Figueroa, assistant professor of health policy and management at Harvard T.H. Chan School of Public Health, and Irene Papanicolas of the London School of Economics. The two researchers began the ICCONIC project because, previously, little was known about differences in spending and utilization of care for HNHC patients across health systems. Even though these patients constitute a relatively small segment of the population, they account for a disproportionately large share of healthcare expenditures—and their numbers are expected to grow over time as populations age.

The researchers looked at the care trajectories of HNHC patients in 11 countries, including the U.S., Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, and Switzerland. They modeled the experiences of two types of patient “personas”: a frail older adult recovering from a hip fracture, and an older person with complex multimorbidity who is hospitalized with heart failure and also has diabetes.

The research showed that average use of health care services and spending vary substantially across countries for both an older person with complex multimorbidity and a frail older person who sustains a hip fracture, with the U.S. spending far more than comparison countries for both personas. Higher costs in the U.S. were driven by higher prices for health care across most settings and above-average use of both rehab and outpatient specialty care.

The research also revealed substantial variation in mortality rates for both personas across countries. A November 10, 2021 article in The Guardian highlighted one of the ICCONIC project’s findings—that England had the highest death rates of frail and older hospitalized patients among all the countries in the study.

In the U.S., higher spending did not necessarily lead to better long-term outcomes for HNHC patients, the research found.

Understanding what drives the differences in cost and quality of care across countries is an important step toward improving high-need patients’ lives and optimizing health system performance, according to Figueroa.

Read the studies: Special Issue: International Comparisons of High-Need, High-Cost Patients: New Directions in Research and Policy

Read the Guardian article: England has highest death rates of older patients in western world, study finds

  1. Bible verses for today’s meditation and inspiration: Matthew E. McLaren
  2. Isaiah 55:7
    Let the wicked forsake his way, and the unrighteous man his thoughts; let him return to the Lord, that he may have compassion on him, and to our God, for he will abundantly pardon.
  3. 1 John 2:2
    He is the propitiation for our sins, and not for ours only but also for the sins of the whole world.
  4. 1 Peter 4:8
    Above all, keep loving one another earnestly, since love covers a multitude of sins.
  5. Acts 17:30
    The times of ignorance God overlooked, but now he commands all people everywhere to repent
  6. Isaiah 43:25
    I, I am he who blots out your transgressions for my own sake, and I will not remember your sins.
  7. Matthew 6:14
    For if you forgive other people when they sin against you, your heavenly father will also forgive you.
  8. Mark 11:25
    And when you stand praying, if you hold anything against anyone, forgive them, so that your father in heaven may forgive you your sins.
  9. 1 John 2:12
    I am writing to you, little children, because your sins are forgiven for his name’s sake.
  10. Psalm 32:1
    Blessed is the one whose transgressions are forgiven, whose sins are covered.
  11. Proverbs 17:9
    Love prospers when a fault is forgiven, but dwelling on it separates close friends.
  12. Galatians 6:1
    Brothers, if anyone is caught in any transgression, you who are spiritual should restore him in a spirit of gentleness. Keep watch on yourself, lest you too be tempted.
  13. Daniel 9:9
    The Lord our God is merciful and forgiving, even though we have rebelled against him.
  14. Isaiah 1:18
    “Come now, let us settle the matter,” says the Lord. “Though your sins are like scarlet, they shall be as white as snow; though they are red as crimson, they shall be like wool.”
  15. Hebrews 10:17
    Then he adds, “I will remember their sins and their lawless deeds no more.”
  16. James 5:16
    Therefore, confess your sins to one another and pray for one another, that you may be healed. The prayer of a righteous person has great power as it is working.
  17. Luke 6:27
    But I say to you who hear: love your enemies, do good to those who hate you

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